锁孔手术入路在后循环动脉瘤夹闭术中的初步应用

目的 探讨锁孔入路微创手术治疗后循环动脉瘤的可行性及其疗效.方法 后循环动脉瘤患者12例,包括基底动脉(BA)6例(基底动脉分叉部1例,基底动脉-小脑上动脉3例,基底动脉-大脑后动脉1例,大脑后动脉-基底动脉-小脑上动脉1例),大脑后动脉(PCA)5例(PCA1-2段1例,PCA2段2例,PCA2-3段2例),小脑后下动脉(PICA)1例.6例BA远端动脉瘤及2例PCA1-2段动脉瘤均采用经眉弓锁孔入路,3例PCA2-3段动脉瘤采用颞下锁孔入路,1例PICA动脉瘤采用枕下外侧锁孔入路.结果 12例手术中,动脉瘤完全夹闭9例,2例PCA2-3段巨大动脉瘤行孤立术及血栓切除术,术后脑血管造影(DSA)复查发现1例PICA动脉瘤夹闭不全,该动脉瘤呈葫芦形,手术中夹闭了动脉瘤远端大半,随访6个月无再出血.所有患者术中无动脉瘤破裂出血,出院时,患者均神志清楚,无肢体活动障碍等残疾.结论 锁孔入路下,可磨除前床突或后床突骨质,增加对后循环动脉瘤夹闭操作的空间;载瘤血管近端球囊导管控制可增加手术的安全性;神经导航有助于对PCA远端动脉瘤的快速定位.个体化的锁孔手术入路应用于后循环动脉瘤手术行之有效.     

大脑后动脉动脉瘤的显微手术治疗

大脑后动脉(PCA)动脉瘤比较少见,占颅内动脉瘤的0.8%～2.3%〔1〕。既往系统研究PCA动脉瘤的报道少见。我们报道近15年来手术治疗的12例PCA动脉瘤,并详细讨论其显微解剖、手术入路、手术方法等有关问题。1　临床资料男9例,女3例,平均年龄42(19～62)岁。7例囊性动脉瘤,4例巨大动脉瘤,1例梭形动脉瘤。8例患者首发症状为蛛网膜下腔出血,2例表现为动眼神经麻痹(其中1例合并偏瘫),1例以癫痫为首发症状,1例因头痛经CT检查发现动脉瘤。所有患者均经脑血管造影检查,部分患者经CT、MRI检查。动脉瘤大小:直径<1.0cm者2例,1.0～2.5cm者6例,>2.5cm…     

未成年人颅内动脉瘤临床研究

目的 探讨末成年人颅内动脉瘤的发病方式、影像学特点及其治疗.方法 对1985至2008年北京宣武医院39例末成年人(0～18岁,男24例,女15例)颅内动脉瘤的影像学特征、治疗方式及其疗效进行回顾性分析.治疗方法:神经介入治疗22例;显微外科治疗8例;载瘤动脉自行闭塞而自愈者3例;术前动脉瘤再破裂死亡1例,未治疗5例.30例接受治疗的患者出院时恢复良好Glasgow结果评分[(GOS)4 ～5分]28例,死亡1例,致残(GOS 2分)1例,随访过程中有1例动脉瘤栓塞后复发行手术治疗.结果 未成年人颅内动脉瘤占同期颅内动脉瘤的2.2％.发病方式:以蛛网膜下腔出血导致急性剧烈头痛19例,长期头晕头痛7例,一侧肢体无力6例,眼球活动障碍5例,无症状偶然发现2例,外伤后鼻衄1例.共发现44个颅内动脉瘤,其中前循环31个,后循环13个,后循环动脉瘤比例为29.5％;动脉瘤部位:大脑中动脉10例,海绵窦段颈内动脉6例,床突段及床突上段颈内动脉6例,基底动脉6例,前交通动脉及大脑前动脉4例,大脑后动脉4例,椎动脉3例,后交通动脉、脉络膜前动脉各2例,眼动脉1例.巨大动脉瘤(直径＞ 25 mm)12个.结论 (1)未成年人颅内动脉瘤的发病率男性高于女性;(2)大脑中动脉是未成年人颅内动脉瘤的好发部位;(3)复杂性动脉瘤(巨大型、外伤性、梭形动脉瘤)比例较高;(4)未成年人颅内动脉瘤治疗难度较大,部分病例需采用载瘤动脉闭塞或搭桥后孤立动脉瘤的方法治疗,但预后较好.     

颅内后循环动脉瘤的手术策略

颅内后循环动脉瘤是指发生于基底动脉、椎动脉颅内段及椎,基底动脉分支的动脉瘤。后循环动脉瘤约占颅内动脉瘤的15％,其中基底动脉分叉部及主要分支大脑后动脉和小脑上动脉动脉瘤最为常见,约占后循环动脉瘤的50％。     

Willis环变异与颅内动脉瘤关系的分析

目的分析Willis环变异与颅内动脉瘤的关系。方法对我院2018年5月至2019年5月收治的76例颅内动脉瘤患者的CT血管成像(CTA)资料进行回顾性分析,对比前交通动脉瘤与后交通动脉瘤患者的Willis环变异情况,探讨Willis环变异与颅内动脉瘤之间的关系。结果前交通动脉瘤患者单侧胚胎型大脑后动脉、双侧胚胎型大脑后动脉、A1段纤细或缺如占比分别为34.4%、62.5%、78.1%,与后交通动脉瘤患者的59.1%、31.8%、50.0%对比具有统计学差异(P0.05)。结论前交通动脉瘤的发生与双侧胚胎型大脑后动脉、A1段纤细及缺如有关,后交通动脉瘤的发生与单侧胚胎型大脑后动脉有关。     

脑动脉瘤破裂手术前后的脑灌注成像探讨

目的:通过CT灌注成像观察颅内动脉瘤破裂出血手术前后的脑血流变化,为临床后续治疗提供相关信息。方法:回顾性分析颅内动脉瘤破裂手术前、后临床资料44例。所选患者术前行CT血管成像(CTA)和CT灌注成像(CTP)检查,并于术后1周行CTP复查。分别测量前后两次CTP的大脑前动脉区(ACA区)、大脑中动脉区(MCA区)、大脑后动脉区(PCA区)及基底节区灌注值。结果:44例入选患者中,34例伪彩图肉眼可见好转,患者的ACA区、MCA区、PCA区及基底节区脑血流量(CBF)与平均通过时间(MTT)变化差异有统计学意义(P<0.05);8例肉眼可见局部灌注减低区的MTT值均延长、CBF值减低;2例灌注值未见明显异常。所有患者的脑血容量(CBV)值变化差异均无统计学意义。结论:颅内动脉瘤破裂手术前及手术后存在脑灌注调整,视个体和病情各异,脑灌注也将发生相应的变化。     

单胎妊娠合并再生障碍性贫血孕妇母婴结局及影响因素

目的：探究单胎妊娠合并再生障碍性贫血(PCAA)孕妇母婴结局及相关影响因素。方法：回顾性分析2011年1月至2020年1月内蒙古医科大学附属医院诊治的54例单胎PCAA患者(PCAA组)的临床资料,选取同期62例产检健康的单胎妊娠孕妇作为对照组。比较两组分娩情况及母婴不良结局情况;根据PCAA孕妇不良结局分为结局不良组、非结局不良组,比较不同结局组孕妇临床资料,采用多因素Logistic回归分析影响因素。结果：54例PCAA孕妇中,有35例(64.81%)接受孕期输血治疗;胎死宫内2例,52例患者活产分娩中新生儿死亡2例,存活新生儿出生体重1 520～3 780 (2 741.56±598.47) g。PCAA组孕妇分娩孕周小于对照组、剖宫产率大于对照组(P<0.05);PCAA组重度子痫前期、妊娠期高血压疾病、产后出血、早产发生率(12.96%、16.67%、11.11%、25.93%)高于对照组(1.61%、3.23%、1.61%、8.06%)(P<0.05)。PCAA孕妇共22例(40.74%)发生不良结局;多因素Logistic回归分析显示：血小板计数<10×...     

显微手术治疗大脑后动脉巨大动脉瘤的临床分析

目的 探讨显微手术时大脑后动脉巨大动脉瘤的治疗效果.方法 对4例大脑后动脉巨大动脉瘤进行显微外科治疗,其中1例行夹闭术;1例行动脉瘤切除后血管重建术;1例行动脉瘤近侧的PCA结扎后切除动脉瘤;1例因载瘤动脉内大量血栓形成已闭塞,直接行动脉瘤切除.结果 4例患者经显微外科手术治疗后恢复良好,术后影像学复查显示动脉瘤消失,无脑缺血表现,临床无神经系统缺失症状.结论 经颞下入路显微外科手术是治疗大脑后动脉巨大动脉瘤的有效方法.     

腔隙中风

腔隙中风是指脑动脉深穿支管壁渗血、管腔阻塞后,残留在大脑深部或脑干的小软化灶,半数病人可伴特征性的临床综合征,发生率约占中风总数的19％,远较脑动脉瘤、脑动静脉畸形的发病率高,逐渐受到人们的重视。一、历史“腔隙”(Lacune)这个名词由 Burand-Fardel     

颅内动脉瘤直接手术

1978～1987年收治的颅内动脉瘤23例,施行直接手术治疗的21例。年龄27～69岁,50岁以上者占47.6％。21例中颈内动脉瘤17例,前交通动脉瘤2例,大脑前动脉瘤1例,大脑中动脉瘤1例。术前状态Ⅱ级10例、Ⅲ级10例、Ⅴ级1例。治疗佳良率为85.7％,21例中仅1例大脑中动脉瘤死亡,该例术前状态为Ⅴ级,病死率4.8％。本文对手术入路、动脉瘤的处理,术中动脉瘤破裂的预防及处理等进行了讨论。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.